Ueno Shuhei, Kimura Masahiro, Saito Tsuyoshi, Hirokawa Takahisa, Miyai Hirotaka, Ogawa Ryo, Takiguchi Shuji
Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan.
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0151. Epub 2025 Jul 1.
A complication of gastrointestinal anastomosis is anastomotic leakage; the incidence of anastomotic leakage following esophageal cancer surgery remains high. Several factors contribute to anastomotic leakage; however, blood flow to the reconstructed organ is the most significant factor. Currently, indocyanine green (ICG) fluorescence is widely used for evaluating blood flow; however, several issues have been observed, including allergic reactions to the drug. We investigated the usefulness of thermography (TG) for gastrointestinal blood flow evaluation.
Case 1 was a 76-year-old male who underwent thoracoscopic subtotal esophagectomy and gastric conduit reconstruction for esophageal cancer. ICG fluorescence was performed to evaluate gastrointestinal blood flow, and ICG fluorescence and TG were simultaneously performed. The early and final luminescent areas following ICG injection were consistent with the TG images. Case 2 was a 73-year-old male who underwent bypass surgery using a Y-shaped gastric conduit for esophageal cancer with pulmonary invasion. First, TG was simultaneously performed with ICG fluorescence following Y-shaped gastric conduit creation; subsequently, TG was performed again after the gastric conduit was placed via the subcutaneous route. As in Case 1, the TG images were consistent with the blood flow boundaries identified using ICG. Furthermore, the TG images, after the gastric conduit was placed in the neck region, showed blood flow boundaries.
Although accumulation of similar cases is necessary, TG has the potential for use as an auxiliary diagnostic tool in clinical practice. Moreover, it is highly useful for indicating the possibility of reevaluation at short intervals, which is difficult to evaluate using ICG.
胃肠道吻合术的一个并发症是吻合口漏；食管癌手术后吻合口漏的发生率仍然很高。有几个因素导致吻合口漏；然而，重建器官的血流是最重要的因素。目前，吲哚菁绿（ICG）荧光被广泛用于评估血流；然而，已经观察到几个问题，包括对该药物的过敏反应。我们研究了热成像（TG）在评估胃肠道血流方面的实用性。
病例1是一名76岁男性，因食管癌接受了胸腔镜下食管次全切除术和胃代食管重建术。进行ICG荧光检查以评估胃肠道血流，并同时进行ICG荧光和TG检查。注射ICG后的早期和最终发光区域与TG图像一致。病例2是一名73岁男性，因食管癌伴肺侵犯接受了使用Y形胃代食管的旁路手术。首先，在创建Y形胃代食管后，同时进行TG和ICG荧光检查；随后，在通过皮下途径放置胃代食管后再次进行TG检查。与病例1一样，TG图像与使用ICG确定的血流边界一致。此外，在胃代食管放置在颈部区域后，TG图像显示了血流边界。
尽管需要积累更多类似病例，但TG有潜力在临床实践中用作辅助诊断工具。此外，它对于表明短时间内重新评估的可能性非常有用，而这用ICG很难评估。
